Case Study: Accessing VA VistA EHR using HealthShare

SUMMARY

The Department of Veterans Affairs (VA) Veterans Health Administration (VHA) provides a full spectrum of healthcare services to more than 9 million American Veterans, service members, and their dependents. A critical component of this veteran care is pharmacy services, overseen by the Pharmacy Benefits Management (PBM) Office; yet VA-run pharmacies have struggled in their ability to deliver efficient and effective patient care. Multiple disparate and complicated legacy Pharmacy Information Technology (IT) systems provide limited access to crucial clinical and medical data stored in the VHA’s separate HealthShare platform, creating significant obstacles and inefficiencies for clinicians and pharmacists who often have to make decisions without the information they need to safely process and dispense medications to veterans.

With this new, user-friendly interface, pharmacists can now make better informed decisions, using clinical knowledge and patient-specific information that is intelligently filtered, organized, and presented in real-time to improve Veteran healthcare outcomes.

THE CHALLENGE

In order to successfully integrate the VistA and HealthShare systems through a graphical user interface, a process for extracting data from multiple, disparate and very complex platforms and transforming it into a standardized and easily consumable format had to be developed. Internally, HealthShare stores clinical data using a data model called SDA, and consumers of HealthShare can access the patient and clinical data through a few different interfaces. While the HealthShare platform can be viewed in some respects as an ESB with the FHIR interface as just one “adapter”, it also supports HL7 V2, SDA and CCDA. Data can be accessed from the VistA M environment, but the VistA data cannot be accessed from outside the system.

A significant challenge was in extracting data from VistA and creating an appropriate “adapter” to render the data for the AMPL UI platform.

OUR SOLUTIONS

With its deep expertise in data extraction and transformation, the FTC Development Team orchestrated the scaled agile development of the web-based VA AMPL-UI in the AWS GovCloud using HealthShare as part of the first (FHIR) interoperability production integration. FTC’s AMPL GUI consists of three layers:

The Presentation Tier
First, the frontend portal is an Angular web application built with Node.JS, using Maven to build the service component written in Java.

The Service Tier
The second tier is comprised of a set of REST services, a business-engine developed under the Spring Boot framework. The Services are implemented as J2EE Servlets and are executing in a Tomcat Servlet container.

The Data Tier
The third tier is external to the application’s boundary. The FTC Team chose to use the HL7 FHIR standard to make the most of HealthShare’s direct access to the VistA M environment and employ its enterprise-wide aggregated view of patient data. The data visualized by the AMPL-UI application is obtained via HL7 FHIR compliant REST services hosted by the HealthShare system.

THE RESULTS

The FTC Team’s success in creating an AWS cloud-based application that interfaces with multiple systems enterprise-wide to support the customer’s need is already having a significant impact. Just six months out from its deployment, FTC’s AMPL-UI design has made formerly incompatible systems fully interoperable and has heightened their functionality as a result. Harnessing the capabilities in HealthShare, the FTC team has been able to seamlessly integrate in real-time with VistA systems to extract and present critical pharmacy data into the web-based AMPL UI platform. Indeed, the backend service component has been so successful in connecting to Healthshare as a data source that it has now replaced the legacy RPC broker and VisaLink methods of accessing VistA data enterprise-wide.

With the enhanced and responsive ability to search patient data, view analytics, manage workflows, provide decision support and real-time access to patient history, patient profiles and relationship management, the VA staff is now able to optimize its day-to-day activities and reassess the distribution of resources needed for optimal patient outcomes. Furthermore, with a single point of access to patient medical data in a clearer, comprehensive and more user-friendly display, clinicians and pharmacists can now deliver faster service and better care to veterans.

INSIGHTS

Healthcare organizations manage hundreds of different specialized applications, systems, and devices that must work together efficiently, securely, and without interruption, and with more than 11,600 users requiring access to critical patient information across multiple systems, the VHA’s PBM Office is no exception.

Pharmacy clinicians need decision support systems that reduce the risk of errors and adverse events and maximize patient safety, quality of care and health outcomes while enhancing both provider and patient satisfaction.

FTC addressed this need with a highly-specialized web-based user interface that employs an integration engine with HL7®-messaging-based connectivity and that is relatively easy to set up at a departmental level. Health Connect combines the sophisticated service-oriented architecture (SOA) features found in ESBs with the ease of use and rapid integration associated with messaging engines.

The FTC Team has solved a complex enterprise-wide problem using data fragmentation over a robust FHIR API gateway using HealthShare capable of accessing, aggregating, integrating, standardizing and processing health data from multiple sources to extract meaningful information and business insights.